PeachCare

PeachCare is the Georgia version of SCHIP . . . the State Children’s Health Insurance Plan. PeachCare is funded through taxpayer dollars, with roughly a third coming from federal taxes.

In addition to medical care, the PeachCare plan cover’s dental benefits for qualified children up to age 18. In addition to funding issues, Peachare (and any other taxpayer funded health care plans) face major hurdles for accessability.

Many providers are refusing to service PeachCare/Medicaid patients due to the low reimbursement rates. In 1999 roughly 260 dentists accepted PeachCare/Medicaid as a form of payment. The state agreed to increase reimbursement rates which led to an increase to 1800 dental providers over the next few years.

That number is now down to less than 600 participating dental providers.

Every time a PeachCare/Medicaid patient is treated, the dental provider loses money unless they are running some kind of scam. Georgia is not the only state with disappearing providers. Here is a letter to the editor from a dentist in California.

When I first started in Gilroy from scratch in the early ’80s, I found the Denti-Cal program very useful. It worked well and “saved my bacon” during those early days of getting my practice started.

Then things suddenly changed! About 1985 we suddenly found that whenever we submitted a Denti-Cal claim for more than $100, they found a reason to not pay.

So, without being able to do any substantial work and get paid, I had to reluctantly drop the program.

Zip forward to the late ’90s. I wanted to be a good citizen and do my duty for society’s unfortunate, so we tried Denti-Cal again. We found three major problems. First, the reimbursement level was 20 to 40 percent of our normal fees; and with a business overhead of well over 50 percent. This meant doing Denti-Cal at a financial loss. Second, we found it very difficult to get paid at all, even at those low rates due to massive bureaucratic red-tape. And third, we found that Denti-Cal patients were not responsible enough to keep their appointments, adding insult to injury! (Link to letter)

One of my clients recently stopped accepting PeachCare/Medicaid. He can no longer afford to provide the level of service his patients deserve based on the low reimbursement from this taxpayer funded program.

Federal funds are part of the Spendulus Bill are not the answer. No one is served when the idea is to expand eligibility without addressing the shortage of dentists willing to serve this population base.

Just another crazy government idea gone bad and a total waste of taxpayer dollars.

Comments

Your comments are accurate. The scariest thing about Medicaid and PeachCare is what sort of treatment your children might receive.

Most dentists have an overhead of 55-70%. At an average of 30% of their average fees, dentists lose money treating Medicaid and PeachCare patients. So what are their logical options?

1. A dentist can merely resign himslef to lose money treating these patients, and charge other patients more. However, private patients are not dumb, and they will gravitate to non-Medicaid/PeachCare practices where they are not subsidizing the treatment of other patients.

2. The dentist can bill Medicaid fraudulently. Very few choose this, as loss of license and prison is pretty scarey.

3. The dentists can herd as many Medicaid/PeachCare patients in for appointments as possible, and do as much treatment on them as possible per visit, whether it is needed or not. This is in actual fact the most common modeality employed to treat such patients.

A chain of dental clinics recently got in trouble for this. They made it plain that contracting dentists were expected to do a minimum of 4 stainless steel crowns per hour on kids, (Stainless steel crowns net the most Medicaid/PeachCare reimbursement in per unit of time spent.)

A few years ago, a child patient died in an office in Albany due to anesthetic overdose. It is notoriously difficult to get Medicaid and PeachCare kids to keep their appointments. So once one is in the chair, dentists try to do all the work they can in one appointment. In this case, the dentist gave too much anesthetic to try do dental treatment on a small child.

You don’t want ANYONE to try to do treatment on your children under duress, and this is exactly what Medicaid and Peachcare force dentists to do. If you expect the government to provide healthcare for your child, don’t expect it to be very good.